In my career, there have been many things I am fortunate enough to be proud of. Yet one of the things I feel most strongly about is the culture we created during the ten years I was at Aetna, and its enduring impact. In my experience, it is the leader – the CEO – who plays the crucial role in creating and “owning” an organization’s culture, setting the tone, and executing on that consistently. We know a culture doesn’t just happen; it is the result of what you do every day.

I believe in the power of a positive, high-performance culture, which begins with strong ethical values at the core. When I was at Aetna, we worked to create the culture and values with input from our then ~40,000 employees. We felt having employee insights early and often in the process was critical to our long-term success.

The single most important business reason to create a positive high-performance culture is the level and value of information leaders obtain when people are willing to discuss issues and problems. We know failures happen. When they occur, the leader needs to know what happened and what to do. In a negative culture people may try to cover mistakes and problems, and that undermines any real shot at performance improvement. In a positive and supportive culture, people will be more open to having fact-based discussions about problems, thereby allowing leaders to address those issues head on. As I have said many times, people are much more interested in meeting expectations than demands.

Your corporate culture: is it what you think it is?

I was at Aetna during a time of massive change. We were losing $1 million per day on average, and rapidly losing the confidence of members, customers, brokers and investors. Doctors were furious with us. We had also lost the support of our employees. We soon learned that they were demoralized and beaten down because of the poor performance of the company, the strained relationships with our constituents and the constant negativity in the media. Many of our employees were embarrassed to work for Aetna. We could not be successful in rebuilding the company without employees who were engaged and committed to the company’s success. Employees were our most important assets on our path to rebuilding. My job, and the job of the entire leadership team, was to re-engage the employees. Part of that came from working to fix the company so that we could see performance improvements. But we also needed to understand what led to this dysfunctional state.

Something I realized early on in my career: if you ask a leadership team what the culture of a company is, you will get an answer. But the real answer is how the company’s employees answer that question. The CEO’s responsibility is to get alignment between those two answers.

We began a series of activities to communicate with employees, including educating them on the reality of our business and its substantial challenges. We also asked for their input. Working with an outside firm, we developed a survey that was distributed to the entire employee population. And we found that our employees had a lot to say. The first year we conducted the voluntary survey we achieved close to a 90% response rate. We also talked to our employees through focus groups and we took what they told us and created company values, which reflected the beliefs of employees at all levels of the company. We reinforced the legitimacy of the values by using them every single day, but also by incorporating survey action items within our business plans each year. Over time, our management team members were held accountable for improvement on survey action items, and their compensation was tied to their performance related to these survey action items.

We probed a number of areas in the survey, but as just one example, we asked whether employees believed that the company was acting in accordance with its values, and whether in fact their own department and their own leader was. We placed a high value on leadership capability, and for performance evaluations of leaders, it was weighted as important as their business results.

The surveys, among other programs, became a regular part of how we communicated about culture and values, as well as a marker for how and whether our employees felt the same as we did about our culture.

Setting the right tone at the top is key. Consistency makes it work.

Much of a leader’s responsibility in creating a positive high-performance culture is setting the right tone, and…